California DSRIP 2.0 Recommendations for Domain 4: Prevention

Transcription

1 Califrnia DSRIP 2.0 Recmmendatins fr Dmain 4: Preventin 1. Brad Recmmendatins a. Leverage the State f Califrnia s recent effrts related t preventin Frm the Let s Get Healthy Califrnia Reprt and the wrk f the HiAP task frce t the 2014 Califrnia Wellness plan, the state has initiated a number f recent initiatives related t preventin and ppulatin health. Reference this excellent wrk within the prject descriptins as apprpriate and use it t guide the specific prjects. b. Leverage the wrk f CPHA members ding clinical and cmmunity preventin CPHA members are ding sme cutting-edge wrk n clinical AND cmmunity preventin. Include a sectin within each dmain 4 prject that highlights existing wrk that is being leveraged r hw this wrk relates t ther existing prjects. Fr example, in relatin t healthy fd initiatives, many hspitals within the DSRIP hspital grup are already wrking n imprving the fd envirnment. The American Heart Assciatin published an article in 2012 which rated cmmunitybased ppulatin appraches based n available peer-reviewed research. Mzaffarian D, et al.; n behalf f the American Heart Assciatin Cuncil n Epidemilgy and Preventin Ppulatin appraches t imprve diet, physical activity, and smking habits: a scientific statement frm the American Heart Assciatin. Circulatin. 2012;126: This is an evidence-based surce might serve as ne guide fr expanding the preventin categries t include cmmunity-based and public plicy appraches. c. Recgnize existing clinical-cmmunity linkages Many, if nt all f the DSRIP hspitals, already have cmmunity linkages. Highlight successful partnerships within the cncept paper. Als ask prviders t identify these linkages as ne f their bjectives. Cnsider setting up learning cmmunities f prviders s leaders can wrk with ther hspitals that are nt s far alng n preventin strategies. d. Rerganize Dmain 4 int five distinct prjects Separate the Millin Hearts Initiative and the Obesity Preventin Initiative s each is its wn prject with distinct metrics and gals.

2 Add a sectin n Tbacc Cntrl rather than spreading tbacc cntrl gals acrss Dmain 4. e. Revise the template used t describe each prject Ratinale/evidence base sectin: Include baseline data abut the Califrnia Medi-Cal ppulatin and each categry; and lay ut what is knwn abut the relevant health disparities. ( Gals/bjectives sectin: Rerganize based n five categries rather than three. Include mre specific, targeted gals that are related t each preventin prject. Cre cmpnents: Lay ut the cmpnents by prject. Clinical event utcmes: Separate clinical and prcess utcmes. Where pssible, cnnect the Dmain 4 effrts t the Categry 3 data that were cllected as part f the DSRIP 2. Specific Recmmendatins n Millin Hearts Initiative Lay ut the relevant data fr the Medi-Cal ppulatin related t cardiac health. Explain hw the risk factrs fr the Medi-Cal differ frm the general ppulatin and then use that data, alng with the Millin Hearts framewrk, t drive strategy. Clarify the cnnectin between data here and the Categry 3 data that was cllected under DRSIP1.0. Hspitals are cllecting at least tw relevant measures which can serve as baseline data: Reprt results f the 30-Day Cngestive Heart Failure Readmissin Rate measure t the State Reprt results f the Hypertensin (HTN): Bld Pressure Cntrl (<140/90 mmhg) measure t the State b. Gals/Objectives Lay ut gals specific t Millin Hearts and cardiac health. Be mre specific abut the disparities that exist and then lay ut targets fr imprvement. An example f such a target culd be t imprve systlic bld pressure numbers amng African-Americans in a system s patient ppulatin. Be mre specific abut the screening targets. Lay ut what is happening nw and hw hspitals will imprve perfrmance. c. Cre Cmpnents The Millin Hearts initiative has tw parts a clinical cmpnent and a cmmunity cmpnent. Include gals related t the cmmunity cmpnent. Examples f bth are laid in this article, The Millin Hearts Initiative Preventing Heart Attacks and Strkes, ChangeLab Slutins/Manel Kappagda JD, MPH Page 2 f 5 1/9/2015

3 Frieden T. and Berwick D., New England Jurnal f Medicine, September 29, Make linkages between the clinical cmpnent and the cmmunity cmpnent. Campus-based strategies related t tbacc use and healthy fd cmpliment the clinical elements f the Millin Heart Initiatives and leverage the wrk n the ther preventin pririties within DSRIP. Examples frm the Frieden and Berwick article include reducing sdium and transfats in fd and implementing plicies t reduce expsure t secnd-hand smke. d. Clinical Event Outcmes Separate clinical utcmes frm imprtant prcess utcmes. Prcess utcmes culd include the items belw (taken frm New Yrk DSRIP): Prviders will develp r partner with cmmunity resurces t expand the availability f evidence-based self-management prgrams such as the Stanfrd Chrnic Disease Self-Management Prgram (CDSMP). Prviders will develp prtcls t refer patients with HTN r at high risk fr nset f hypertensin t cmmunity-based self-management prgrams. Prviders will cllabrate with cmmunity-based self-management prgrams t mnitr prgress f referred patients and make nging recmmendatins. Perfrming prvider systems that serve fd t emplyees, patients and/r the public will imprve the nutritinal quality f fds served, including reducing sdium, by adpting cmprehensive nutritin standards. A prtcl shuld be develped that includes referral t a Health Hme when it is evident that that level f care management may be indicated fr the patient. When a patient is already part f a Health Hme, the prgram shuld include the care manager in all cmmunicatins and cllabrate with that persn as needed. 3. Specific Recmmendatins n Obesity Preventin Clarify the baseline relevant data fr the Medi-Cal ppulatin related t besity and the disparities in besity rates. Clarify the cnnectin between data here and the Categry 3 data that was cllected under DRSIP1.0. Hspitals are cllecting a number f measures which might be relevant including: Reprt results f the Diabetes, shrt-term cmplicatins measure t the State Reprt results f the Uncntrlled Diabetes measure t the State Reprt results f the Child Weight Screening measure t the State Reprt results f the Pediatrics Bdy Mass Index (BMI) measure t the State b. Gals/Objectives The Child Weight screening measure culd help t set a baseline and then a specific target culd be develped frm that baseline. ChangeLab Slutins/Manel Kappagda JD, MPH Page 3 f 5 1/9/2015

4 The gal f reducing disparities in receipt f targeted preventin services is critical but a baseline shuld be indicated and a target r target range established. c. Cre Cmpnents Create a tiered menu f ptins fr institutins. Expand cncepts beynd healthy hspital fd fr thse institutins that are well n the way t addressing the fd envirnment. In additin t PHA s Healthier Hspital Fd Initiative, cnsider referring t Califrnia Healthy Hspital Fd Initiative. ( A number f the public hspitals are part f this effrt already. Perhaps there are sme baseline data. Fr hspitals that have nt started wrking n this issue, cnsider starting with a gal f eliminating SSBs frm all public hspital facilities. Evidence linking SSBs t diabetes is very strng. Many hspitals have already taken this step. Fr example, the San Mate Cunty Health System, has remved sugar-sweetened beverages frm their vending machines and may have a brader plicy n selling SSBs. Implement screening and referral t cmmunity services related t fd insecurity. d. Clinical Event Outcmes Clearly separate clinical utcmes frm imprtant prcess utcmes. Include specific metrics. E.g., X number f patients received screening e. Prcess Outcmes Additinal prcess utcmes might include: Demnstrated partnerships with cmmunity based rganizatins that facilitate patient adherence t relevant treatment. Fd audits f participating hspital facilities indicate that XX% f the beverages are healthy beverages. 4. Specific Recmmendatins n Tbacc Cntrl Clarify the baseline relevant data fr the Medi-Cal ppulatin related t tbacc use and disparities in tbacc use rates. What s the current evidence? Include any relevant data frm DSRIP 1.0 categry 3. Clarify the cnnectin between data here and the Categry 3 data that was cllected under DRSIP1.0. Hspitals are cllecting the fllwing measure which is relevant: Reprt results f the Tbacc Cessatin measure t the State b. Gals/Objectives Identify a specific gal related t smking/tbacc use rates amng the Medi-Cal ppulatin. ChangeLab Slutins/Manel Kappagda JD, MPH Page 4 f 5 1/9/2015

5 c. Cre Cmpnents Expand the cre cmpnents related t tbacc use t include: Adpt tbacc-free utdr plicies n campuses and supprt brader cmmunity plices. Implement the US Public Health Services Guidelines fr Treating Tbacc Use. Use electrnic medical recrds t prmpt prviders t cmplete 5 A's (Ask, Assess, Advise, Assist, and Arrange). Facilitate referrals t the Califrnia Smkers Helpline ( and ther cmmunity-based supprt prgrams. Increase Medicaid cverage f tbacc dependence treatment cunseling and medicatins. Prmte smking cessatin benefits amng Medicaid prviders. ChangeLab Slutins/Manel Kappagda JD, MPH Page 5 f 5 1/9/2015